How to make health care more convenient

Long waits to get an appointment and long waits once arriving at the doctor’s office are a notorious problem. Some have suggested taking lessons from how restaurants operate and others have turned to more thoughtful approaches such as open access scheduling and capacity balancing.

But medical offices will never be as convenient as retail stores that have been designed with the convenience of customers in mind. Unless, of course those medical offices are actually in retail stores. CVS and others have begun to open MinuteClinics and similar concepts in some of their stores. Six MinuteClinics have opened recently in CVS’s in Nashville, according to the Tennessean. The clinics, which are staffed by nurse practitioners are small and focused. They charge $49 for most services. CVS hopes to benefit because MinuteClinic customers are likely to fill prescriptions at CVS and buy OTC products.

A physician in the article questions whether patients will really want to see a nurse practitioner instead of a physician. It’s a fair question. My experience with nurse practitioners (mainly at our pediatrician’s office) has been negative. We’ve been offered bad advice and misdiagnoses. On the other hand, if we need an appointment in a hurry a nurse practitioner is often the only one who’s available anyway. Other people like nurse practitioners because they are perceived to be more empathetic than physicians and less rushed.

A bigger issue may be the MinuteClinic business model. At such a low price point they need to see a lot of patients to generate a profit. The demographic they draw may not be that attractive, and if the clinics become too popular it’s hard to meet the promise of a 15 minute or less wait.

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Welcome Grand Rounds readers! While you are here, please consider visiting the rest of the Health business blog.

September 13, 2005

One thought on “How to make health care more convenient”

  1. As a physician I’ve have very positive experiences with nurse practitioners. When my children need to be checked in some way requiring looking in ears or throat swabbing we are often seen by a nurse practitioner and they do perfectly fine. For more complex issues I know to insist on a physician, but a good nurse practitioner should also know to call in a doctor in such cases. In a group practice this means buttonholing a physician in a hall. In a free-standing site such as a CVS store this would be more difficult and maybe done less often.

    One more point in defense of nurse practitioners: since their time is less costly it is often possible for nurse practitioners to spend more time with a patient and get a better history. The doctor has an advantage of deeper knowledge, but the advent of decision support software for diagnosis provides a role for a less experienced clinician digging deeper by doing the modern equivalent of “hitting the books”. In teaching hospitals this works well with resident being supervised by attending physicians, and one can do the same with nurse practitioners being supervised by physicians.

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